Provider Demographics
NPI:1962509331
Name:BARNSDALL HEALTH CARE, LLC
Entity Type:Organization
Organization Name:BARNSDALL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-847-2572
Mailing Address - Street 1:PO BOX 499
Mailing Address - Street 2:
Mailing Address - City:BARNSDALL
Mailing Address - State:OK
Mailing Address - Zip Code:74002-0499
Mailing Address - Country:US
Mailing Address - Phone:918-847-2572
Mailing Address - Fax:918-847-2698
Practice Address - Street 1:411 S 4TH
Practice Address - Street 2:
Practice Address - City:BARNSDALL
Practice Address - State:OK
Practice Address - Zip Code:74002-0000
Practice Address - Country:US
Practice Address - Phone:918-847-2572
Practice Address - Fax:918-847-2698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKNH5701-5701313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100774040CMedicaid
OK100774040AMedicaid
OK730789665OtherPREVIOUS TAX ID